Medical table of costs Schedule of fees - · PDF fileMedical table of costs Schedule of ... of the Medical Benefits Schedule (MBS). • Therefore, payment for surgical assistants is
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Medical table of costs
Schedule of fees
1 December 2017 to 30 November 2018
Please note: fees in the schedule are payable only to medical practitioners who meet the providereligibility criteria outlined in the current Medicare Benefits Schedule.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 2 of 25
Medical table of costsSchedule of fees
Rules for useThis document outlines the fees payable by workers’ compensation insurers for medical service delivery to workers’compensation claimants in Queensland.
WorkCover support the recent joint publication from RACP and AFOEM regarding low value clinical practices,specifically:
Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient•is unfit for suitable alternative or restricted duties.Do not order X-rays or other imaging for acute nonspecific low back pain, unless there are red flags or other•clinical reasons to suspect serious spinal pathologyDo not prescribe opiates for the treatment of acute or chronic pain without assessing the patient’s clinical•condition, potential side effects, alternative analgesic options, work status, and capacity to perform safetycritical activities such as driving a motor vehicle[1] RACP EVOLVE AFOEM top-five recommendations on low value practices
Fees in this schedule are payable only to medical practitioners who meet the provider eligibility criteria outlined in thecurrent Medical Benefits Schedule (MBS) book.
All conditions detailed in the explanatory notes of the Medicare Benefits Schedule apply also to the workers’compensation medical table of costs with the exception of the following:
Multi-operation rule – fees for two or more procedures under one anaesthetic, other than amputations,•performed on a patient on the one occasion should be calculated using the following rule – 100 per cent forthe item with the greatest fee; plus 75 per cent for each other MBS item.
Assistant’s fee – a flat 20% surgical assistant’s fee is payable when a surgical assistant is employed for•Therapeutic Procedures Category 3,
Subgroup 14 (Hand Surgery) and,•Subgroup15 (Orthopaedic) of the Medical Benefits Schedule (MBS).•Therefore, payment for surgical assistants is not limited to the MBS item numbers that specify•eligibility for a surgical assistant benefit.This should only be charged when clinically indicated. “The predominant consideration when using an•assistant is patient safety, quality of care and overall efficiency.” (AMA List of Medical Services andFees 2011, p.362).Assistance at Operations is defined in MBS Note TN.9.1•
Aftercare – all conditions detailed in the explanatory notes of the Medicare Benefits Schedule apply when•treating injured workers. This includes the conditions surrounding any billing for routine post-operative carewhich is considered to be inclusive of the operation provided. If a patient requires additional services whichare considered to be ‘not normal aftercare’ (NNAC), then the account should be endorsed with NNAC toenable separate payment for those services.
Other services – dental, nursing and allied health services for compensable injuries are covered under the•relevant table of costs for those services.
The attached schedule details the item number and the workers’ compensation fee payable for all fees current as at 1December 2017. All derived fees have been detailed at the end of the schedule commencing on page 19.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 19 of 25
Item No. Description – WorkCover Queensland4 Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential aged
care facility or a service to which another item in the table applies) that requires a short patient history and, ifnecessary, limited examination and managementan attendance on one or more patients at one place on oneoccasioneach patient. *Derived fee: The fee for item 3, plus $25.95 divided by the number of patients seen, up to amaximum of six patients. For seven or more patients - the fee for item 3 plus $2.00 per patient.
24 Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential agedcare facility or a service to which another item in the table applies), lasting less than 20 minutes and including any ofthe following that are clinically relevant: (a) taking a patient history; (b) performing a clinical examination; (c)arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventivehealth care;for one or more health-related issues, with appropriate documentationan attendance on one or morepatients at one place on one occasioneach patient *Derived fee: The fee for item 23, plus $25.95 divided by thenumber of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 23 plus $2.00per patient.
37 Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential agedcare facility or a service to which another item in the table applies), lasting at least 20 minutes and including any ofthe following that are clinically relevant:(a) taking a detailed patient history;(b) performing a clinical examination;(c)arranging any necessary investigation;(d) implementing a management plan;(e) providing appropriate preventivehealth care;for one or more health-related issues, with appropriate documentationan attendance on one or morepatients at one place on one occasioneach patient *Derived fee: The fee for item 36, plus $25.95 divided by thenumber of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $2.00per patient.
47 Professional attendance by a general practitioner (other than attendance at consulting rooms or a residential agedcare facility or a service to which another item in the table applies), lasting at least 40 minutes and including any ofthe following that are clinically relevant: (a) taking an extensive patient history; (b) performing a clinical examination;(c) arranging any necessary investigation; (d) implementing a management plan; (e) providing appropriate preventivehealth care;for one or more health-related issues, with appropriate documentationan attendance on one or morepatients at one place on one occasioneach patient *Derived fee: The fee for item 44, plus $25.95 divided by thenumber of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 44 plus $2.00per patient.
58 Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a serviceto which any other item in the table applies), not more than 5 minutes in durationan attendance on one or morepatients at one place on one occasioneach patient, by: (a) a medical practitioner (who is not a general practitioner);or (b) a general practitioner to whom clause2.3.1 applies *Derived fee: An amount equal to $8.50, plus $15.50divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amountequal to $8.50 plus $.70 per patient
59 Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a serviceto which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutesanattendance on one or more patients at one place on one occasioneach patient, by: (a) a medical practitioner (who isnot a general practitioner); or (b) a general practitioner to whom clause2.3.1 applies *Derived fee: An amount equalto $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or morepatients - an amount equal to $16.00 plus $.70 per patient
60 Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a serviceto which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutesanattendance on one or more patients at one place on one occasioneach patient, by: (a) a medical practitioner (who isnot a general practitioner); or (b) a general practitioner to whom clause2.3.1 applies *Derived fee: An amount equalto $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or morepatients - an amount equal to $35.50 plus $.70 per patient
65 Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a serviceto which any other item in the table applies) of more than 45 minutes in durationan attendance on one or morepatients at one place on one occasioneach patient, by: (a) a medical practitioner (who is not a general practitioner);or (b) a general practitioner to whom clause2.3.1 applies *Derived fee: An amount equal to $57.50, plus $15.50divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amountequal to $57.50 plus $.70 per patient
99 Professional attendance on a patient by a specialist practising in his or her specialty if: (a) the attendance is by videoconference; and (b) the attendance is for a service: (i) provided with item104 lasting more than 10 minutes; or (ii)provided with item105; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (a) withina telehealth eligible area; and (b) at the time of the attendanceat least 15 kms by road from the specialist; or (ii) is acare recipient in a residential care service; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginalcommunity controlled health service; for which a direction made under subsection19(2) of the act applies *Derivedfee: 50% of the fee for item 104 or 105. Benefit: 85% of the derived fee
112 Professional attendance on a patient by a consultant physician practising in his or her specialty if: (a) the attendanceis by video conference; and (b) the attendance is for a service: (i) provided with item110 lasting more than 10minutes; or (ii) provided with item116, 119, 132 or 133; and (c) the patient is not an admitted patient; and (d) thepatient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of the attendanceat least 15 kms byroad from the physician; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (a) an aboriginalmedical service; or (b) an aboriginal community controlled health service; for which a direction made undersubsection19(2) of the act applies *Derived fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 20 of 25
149 Professional attendance on a patient by a consultant physician or specialist practising in his or her specialty ofgeriatric medicine if: (a) the attendance is by video conference; and (b) item 141 or 143 applies to the attendance;and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (a) within a telehealth eligiblearea; and (b) at the time of the attendance--at least 15 kms by road from the physician or specialist; or (ii) is a carerecipient in a residential care service; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginalcommunity controlled health service: for which a direction made under subsection 19(2) of the act applies *Derivedfee: 50% of the fee for item 141 or 143. Benefit: 85% of the derived fee
195 Professional attendance by a general practitioner who is a qualified medical acupuncturist, on one or more patients ata hospital, lasting less than 20 minutes and including any of the following that are clinically relevant: (a) taking apatient history; (b) performing a clinical examination; (c) arranging any necessary investigation; (d) implementing amanagement plan; (e) providing appropriate preventive health care; for one or more health-related issues, withappropriate documentation, at which acupuncture is performed by the qualified medical acupuncturist by theapplication of stimuli on or through the skin by any means, including any consultation on the same occasion andanother attendance on the same day related to the condition for which the acupuncture is performed *Derived fee:The fee for item 193, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For sevenor more patients - the fee for item 193 plus $2.00 per patient.
288 Professional attendance on a patient by a consultant physician practising in his or her specialty of psychiatry if: theattendance is by video conference; and item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319,348, 350 or 352 applies to the attendance; and the patient is not an admitted patient; and the patient: is located both:within a telehealth eligible area; and at the time of the attendance - at least 15 kms by road from the physician; or (ii)is a care recipient in a residential care service; or (iii) is a patient of: an aboriginal medical service; or an aboriginalcommunity controlled health service for which a direction made under subsection 19 (2) of the Act applies. *Derivedfee: 50% of the fee for item 291, 293,296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or352.Benefit: 85% of derived fee.
389 Professional attendance on a patient by a consultant occupational physician practising in his or her specialty ofoccupational medicine if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i)provided with item 385 lasting more than 10 minutes; or (ii) provided with item 386; and (c) the patient is not anadmitted patient; and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of theattendance--at least 15 kms by road from the physician; or (ii) is a care recipient in a residential care service; or (iii) isa patient of: (a) an aboriginal medical service; or (b) an aboriginal community controlled health service; for which adirection made under subsection 19(2) of the act applies *Derived fee: 50% of the fee for item 385 or 386. Benefit:85% of the derived fee
414 Professional attendance at other than consulting rooms by a public health physician in the practice of his or herspecialty of public health medicine--attendance for an obvious problem characterised by the straightforward nature ofthe task that requires a short patient history and, if required, limited examination and management *Derived fee: Thefee for item 410, plus $25.45 divided by the number of patients seen, up to a maximum of six patients. For seven ormore patients - the fee for item 410 plus $1.95 per patient.
415 Professional attendance by a public health physician in the practice of his or her specialty of public health medicine atother than consulting rooms, lasting less than 20 minutes and including any of the following that are clinicallyrelevant: (a) taking a patient history; (b) performing a clinical examination; (c) arranging any necessary investigation;(d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health-relatedissues, with appropriate documentation *Derived fee: The fee for item 411, plus $25.45 divided by the number ofpatients seen, up to a maximum of six patients. For seven or more patients - the fee for item 411 plus $1.95 perpatient.
416 Professional attendance by a public health physician in the practice of his or her specialty of public health medicine atother than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:(a) taking a detailed patient history; (b) performing a clinical examination; (c) arranging any necessary investigation;(d) implementing a management plan; (e) providing appropriate preventive health care; for one or more health-relatedissues, with appropriate documentation *Derived fee: The fee for item 412, plus $25.45 divided by the number ofpatients seen, up to a maximum of six patients. For seven or more patients - the fee for item 412 plus $1.95 perpatient.
417 Professional attendance by a public health physician in the practice of his or her specialty of public health medicine atother than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:(a) taking an extensive patient history; (b) performing a clinical examination; (c) arranging any necessaryinvestigation; (d) implementing a management plan; (e) providing appropriate preventive health care; for one or morehealth-related issues, with appropriate documentation *Derived fee: The fee for item 413, plus $25.45 divided by thenumber of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 413 plus$1.95 per patient.
2122 Professional attendance not in consulting rooms of at least 5 minutes in duration (whether or not continuous) by amedical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultationwith a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in aresidential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of theattendance--at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendanceon one or more patients at one place on one occasion--each patient *Derived fee: The fee for item 2100 plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item2100 plus $2.00 per patient.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 21 of 25
2125 Professional attendance of at least 5 minutes in duration (whether or not continuous) by a medical practitionerproviding clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist orconsultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion--each patient *Derived fee:The fee for item 2100 plus $46.70 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - the fee for item 2100 plus $3.30 per patient.
2137 Professional attendance not in consulting rooms of less than 20 minutes in duration (whether or not continuous) by amedical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultationwith a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in aresidential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of theattendance--at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendanceon one or more patients at one place on one occasion--each patient *Derived fee: The fee for item 2126 plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item2126 plus $2.00 per patient.
2138 Professional attendance of less than 20 minutes in duration (whether or not continuous) by a medical practitionerproviding clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist orconsultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion--each patient *Derived fee:The fee for item 2126 plus $46.70 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - the fee for item 2126 plus $3.30 per patient.
2147 Professional attendance not in consulting rooms of at least 20 minutes in duration (whether or not continuous) by amedical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultationwith a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in aresidential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of theattendance--at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendanceon one or more patients at one place on one occasion--each patient *Derived fee: The fee for item 2143 plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee foritem 2143 plus $2.00 per patient.
2179 Professional attendance of at least 20 minutes in duration (whether or not continuous) by a medical practitionerproviding clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist orconsultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion--each patient *Derived fee:The fee for item 2143 plus $46.70 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - the fee for item 2143 plus $3.30 per patient.
2199 Professional attendance not in consulting rooms of at least 40 minutes in duration (whether or not continuous) by amedical practitioner providing clinical support to a patient who: (a) is participating in a video conferencing consultationwith a specialist or consultant physician; and (b) is not an admitted patient; and (c) is not a care recipient in aresidential care service; and (d) is located both: (i) within a telehealth eligible area; and (ii) at the time of theattendance--at least 15 kms by road from the specialist or physician mentioned in paragraph (a); for an attendanceon one or more patients at one place on one occasion--each patient *Derived fee: The fee for item 2195 plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee foritem 2195 plus $2.00 per patient.
2220 Professional attendance of at least 40 minutes in duration (whether or not continuous) by a medical practitionerproviding clinical support to a patient who: (a) is participating in a video conferencing consultation with a specialist orconsultant physician; and (b) is a care recipient in a residential care service; and (c) is not a resident of a self-contained unit; for an attendance on one or more patients at one place on one occasion--each patient *Derived fee:The fee for item 2195 plus $46.70 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - the fee for item 2195 plus $3.30 per patient.
2553 Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutesand including any of the following that are clinically relevant: (a) taking a detailed patient history; (b) performing aclinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providingappropriate preventive health care; for one or more health-related issues, with appropriate documentation, and thatcompletes the minimum requirements of the asthma cycle of care *Derived fee: The fee for item 2552, plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee foritem 2552 plus $2.00 per patient.
2559 Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutesand including any of the following that are clinically relevant: (a) taking an extensive patient history; (b) performing aclinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providingappropriate preventive health care; for one or more health-related issues, with appropriate documentation, and thatcompletes the minimum requirements of the asthma cycle of care *Derived fee: The fee for item 2558, plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee foritem 2558 plus $2.00 per patient.
2631 Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), thatcompletes the minimum requirements for a cycle of care of a patient with established diabetes mellitus *Derived fee:An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.For seven or more patients - an amount equal to $16.00 plus $0.70 per patient
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 22 of 25
2633 Professional attendance at a place other than consulting rooms of more than 25 minutes but not more than 45minutes, in duration by a medical practitioner who practises in general practice (other than a general practitioner),that completes the minimum requirements for a cycle of care of a patient with established diabetes mellitus *Derivedfee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of sixpatients. For seven or more patients - an amount equal to $35.50 plus $0.70 per patient
2635 Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medicalpractitioner who practises in general practice (other than a general practitioner), that completes the minimumrequirements for a cycle of care of a patient with established diabetes mellitus *Derived fee: An amount equal to$57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or morepatients - an amount equal to $57.50 plus $0.70 per patient
2723 Professional attendance at a place other than consulting rooms by a medical practitioner who practises in generalpractice (other than a specialist or a consultant physician), for providing focussed psychological strategies forassessed mental disorders by a medical practitioner registered with the chief executive medicare as meeting thecredentialling requirements for provision of this service, and lasting at least 30 minutes, but less than 40 minutes*Derived fee: The fee for item 2721, plus $25.95 divided by the number of patients seen, up to a maximum of sixpatients. For seven or more patients - the fee for item 2721 plus $2.00 per patient.
2727 Professional attendance at a place other than consulting rooms by a medical practitioner who practises in generalpractice (other than a specialist or a consultant physician), for providing focussed psychological strategies forassessed mental disorders by a medical practitioner registered with the chief executive medicare as meeting thecredentialling requirements for provision of this service, and lasting at least 40 minutes *Derived fee: The fee for item2725, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or morepatients - the fee for item 2725 plus $2.00 per patient.
2820 Professional attendance on a patient by a specialist or consultant physician practising in his or her specialty of painmedicine if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item2801 lasting more than 10 minutes; or (ii) provided with item 2806 or 2814; and (c) the patient is not an admittedpatient; and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of theattendance--at least 15 kms by road from the specialist or physician; or (ii) is a care recipient in a residential careservice; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginal community controlled healthservice; for which a direction made under subsection 19(2) of the act applies *Derived fee: 50% of the fee for item2801, 2806 or 2814. Benefit: 85% of the derived fee
3015 Professional attendance on a patient by a specialist or consultant physician practising in his or her specialty ofpalliative medicine if: (a) the attendance is by video conference; and (b) the attendance is for a service: (i) providedwith item 3005 lasting more than 10 minutes; or (ii) provided with item 3010 or 3014; and (c) the patient is not anadmitted patient; and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of theattendance--at least 15 kms by road from the specialist or physician; or (ii) is a care recipient in a residential careservice; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginal community controlled healthservice; for which a direction made under subsection 19(2) of the act applies *Derived fee: 50% of the fee for item3005, 3010 or 3014. Benefit: 85% of the derived fee
5003 Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or aresidential aged care facility or a service to which another item in the table applies) that requires a short patienthistory and, if necessary, limited examination and management--an attendance on one or more patients on oneoccasion--each patient *Derived fee: The fee for item 5000, plus $25.95 divided by the number of patients seen, upto a maximum of six patients. For seven or more patients - the fee for item 5000 plus $2.00 per patient.
5023 Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or aresidential aged care facility or a service to which another item in the table applies), lasting less than 20 minutes andincluding any of the following that are clinically relevant: (a) taking a patient history; (b) performing a clinicalexamination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providingappropriate preventive health care; for one or more health-related issues, with appropriate documentation--anattendance on one or more patients on one occasion--each patient *Derived fee: The fee for item 5020, plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item5020 plus $2.00 per patient.
5043 Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or aresidential aged care facility or a service to which another item in the table applies), lasting at least 20 minutes andincluding any of the following that are clinically relevant: (a) taking a detailed patient history; (b) performing a clinicalexamination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providingappropriate preventive health care; for one or more health-related issues, with appropriate documentation--anattendance on one or more patients on one occasion--each patient *Derived fee: The fee for item 5040, plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item5040 plus $2.00 per patient.
5063 Professional attendance by a general practitioner (other than attendance at consulting rooms, a hospital or aresidential aged care facility or a service to which another item in the table applies), lasting at least 40 minutes andincluding any of the following that are clinically relevant: (a) taking an extensive patient history; (b) performing aclinical examination; (c) arranging any necessary investigation; (d) implementing a management plan; (e) providingappropriate preventive health care; for one or more health-related issues, with appropriate documentation--anattendance on one or more patients on one occasion--each patient *Derived fee: The fee for item 5060, plus $25.95divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item5060 plus $2.00 per patient.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
Effective from 1 December 2017
MBS descriptions and rules apply to all items listed FS900 Page 23 of 25
5220 Professional attendance by a medical practitioner who is not a general practitioner (other than attendance atconsulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies),lasting not more than 5 minutes--an attendance on one or more patients on one occasion--each patient *Derived fee:An amount equal to $18.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - an amount equal to $18.50 plus $.70 per patient
5223 Professional attendance by a medical practitioner who is not a general practitioner (other than attendance atconsulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies),lasting more than 5 minutes, but not more than 25 minutes--an attendance on one or more patients on one occasion--each patient *Derived fee: An amount equal to $26.00, plus $17.50 divided by the number of patients seen, up to amaximum of six patients. For seven or more patients - an amount equal to $26.00 plus $.70 per patient
5227 Professional attendance by a medical practitioner who is not a general practitioner (other than attendance atconsulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies),lasting more than 25 minutes, but not more than 45 minutes--an attendance on one or more patients on oneoccasion--each patient *Derived fee: An amount equal to $45.50, plus $15.50 divided by the number of patientsseen, up to a maximum of six patients. For seven or more patients - an amount equal to $45.50 plus $.70 per patient
5228 Professional attendance by a medical practitioner who is not a general practitioner (other than attendance atconsulting rooms, a hospital or a residential aged care facility or a service to which another item in the table applies),lasting more than 45 minutes--an attendance on one or more patients on one occasion--each patient *Derived fee:An amount equal to $67.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. Forseven or more patients - an amount equal to $67.50 plus $.70 per patient
6016 Professional attendance on a patient by a specialist practising in his or her specialty of neurosurgery if: (a) theattendance is by video conference; and (b) the attendance is for a service: (i) provided with item 6007 lasting morethan 10 minutes; or (ii) provided with item 6009, 6011, 6013 or 6015; and (c) the patient is not an admitted patient;and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of the attendance--atleast 15 kms by road from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of:(a) an aboriginal medical service; or (b) an aboriginal community controlled health service; for which a direction madeunder subsection 19(2) of the act applies *Derived fee: 50% of the fee for item 6007, 6009, 6011, 6013 or 6015.Benefit: 85% of the derived fee
6026 Professional attendance on a patient by an addiction medicine specialist in the practice of his or her specialty, if: (a)the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 6018 or 6019and lasting more than 10 minutes; or (ii) provided with item 6023 or 6024; and (c) the patient is not an admittedpatient; and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of theattendance--at least 15 km by road from the addiction medicine specialist; or (ii) is a care recipient in a residentialcare service; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginal community controlled healthservice; for which a direction made under subsection 19 (2) of the act applies *Derived fee: 50% of the fee for item6018, 6019, 6023, or 6024 Benefit: 85% of the derived fee
6060 Professional attendance on a patient by a sexual health medicine specialist in the practice of his or her specialty if:(a) the attendance is by video conference; and (b) the attendance is for a service: (i) provided with item 6051 or 6052and lasting more than 10 minutes; or (ii) provided with item 6057 or 6058; and (c) the patient is not an admittedpatient; and (d) the patient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of theattendance--at least 15 km by road from the sexual health medicine specialist; or (ii) is a care recipient in a residentialcare service; or (iii) is a patient of: (a) an aboriginal medical service; or (b) an aboriginal community controlled healthservice; for which a direction made under subsection 19 (2) of the act applies *Derived fee: 50% of the fee for item6051, 6052, 6057 or 6058 Benefit: 85% of the derived fee
13210 Professional attendance on a patient by a specialist practising in his or her specialty if: (a) the attendance is by videoconference; and (b) item 13209 applies to the attendance; and (c) the patient is not an admitted patient; and (d) thepatient: (i) is located both: (a) within a telehealth eligible area; and (b) at the time of the attendanceat least 15 kms byroad from the specialist; or (ii) is a care recipient in a residential care service; or (iii) is a patient of: (a) an AboriginalMedical Service; (b) or an Aboriginal Community Controlled Health service for which a direction made undersubsection 19 (2) of the act applies *Derived fee: 50% of the fee for item 13209. Benefit: 85% of the derived fee
15003 Radiotherapy, superficial (including treatment with x-rays, radium rays or other radioactive substances), not being aservice to which another item in this Group applies - each attendance at which fractionated treatment is given - 2 ormore fields up to a maximum of 5 additional fields *Derived fee: The fee for item 15000 plus for each field in excessof 1, an amount of $17.10
15009 Radiotherapy, superficial attendance at which a single dose technique is applied - 2 or more fields up to a maximumof 5 additional fields *Derived fee: The fee for item 15006 plus for each field in excess of 1, an amount of $18.55
15103 Radiotherapy, deep or orthovoltage each attendance at which fractionated treatment is given at 3 or more treatmentsper week - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) *Derived fee:The fee for item 15100 plus for each field in excess of 1, an amount of $18.80
15109 Radiotherapy, deep or orthovoltage each attendance at which fractionated treatment is given at 2 treatments perweek or less frequently - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)*Derived fee: The fee for item 15106 plus for each field in excess of 1, an amount of $22.70
15115 Radiotherapy, deep or orthovoltage attendance at which a single dose technique is applied - 2 or more fields up to amaximum of 5 additional fields (rotational therapy being 3 fields) *Derived fee: The fee for item 15112 plus for eachfield in excess of 1, an amount of $47.30
15214 Radiation oncology treatment, using cobalt unit or caesium teletherapy unit - each attendance at which treatment isgiven 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) *Derived fee: The feefor item 15211 plus for each field in excess of 1, an amount of $31.90
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
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15230 Radiation oncology treatment, using a single photon energy linear accelerator with or without electron facilities - eachattendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapybeing 3 fields) - treatment delivered to primary site (lung) *Derived fee: The fee for item 15215 plus for each field inexcess of 1, an amount of $37.95
15233 Radiation oncology treatment, using a single photon energy linear accelerator with or without electron facilities - eachattendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapybeing 3 fields) - treatment delivered to primary site (prostate) *Derived fee: The fee for item 15218 plus for each fieldin excess of 1, an amount of $37.95
15236 Radiation oncology treatment, using a single photon energy linear accelerator with or without electron facilities - eachattendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapybeing 3 fields) - treatment delivered to primary site (breast) *Derived fee: The fee for item 15221 plus for each field inexcess of 1, an amount of $37.95
15239 Radiation oncology treatment, using a single photon energy linear accelerator with or without electron facilities - eachattendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapybeing 3 fields) - treatment delivered to primary site for diseases and conditions not covered by items 15230, 15233 or15236 *Derived fee: The fee for item 15224 plus for each field in excess of 1, an amount of $37.95
15242 Radiation oncology treatment, using a single photon energy linear accelerator with or without electron facilities - eachattendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapybeing 3 fields) - treatment delivered to secondary site *Derived fee: The fee for item 15227 plus for each field inexcess of 1, an amount of $37.95
15260 Radiation oradiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energyof at least 10mv photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up toa maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (lung)ncologytreatment, using a dual photon energy linear accelerator with a minimum higher energy of 10mv photons or greater,with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (lung) *Derived fee: The feefor item 15245 plus for each field in excess of 1, an amount of $37.95
15263 Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least10mv photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to amaximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (prostate)*Derived fee: The fee for item 15248 plus for each field in excess of 1, an amount of $37.95
15266 Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least10mv photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to amaximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (breast)*Derived fee: The fee for item 15251 plus for each field in excess of 1, an amount of $37.95
15269 Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least10mv photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to amaximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site for diseases andconditions not covered by items 15260, 15263 or 15266 *Derived fee: The fee for item 15254 plus for each field inexcess of 1, an amount of $37.95
15272 Radiation oncology treatment, using a dual photon energy linear accelerator with a minimum higher energy of at least10mv photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to amaximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to secondary site *Derivedfee: The fee for item 15257 plus for each field in excess of 1, an amount of $37.95
16399 Professional attendance on a patient by a specialist practising in his or her specialty of obstetrics if: (a) theattendance is by video conference; and (b) item 16401, 16404, 16406, 16500, 16590 or 16591 applies to theattendance; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (a) within a telehealtheligible area; and (b) at the time of the attendanceat least 15 kms by road from the specialist; or (ii) is a care recipientin a residential care service; or (iii) is a patient of: (a) an Aboriginal Medical Service; (b) or an Aboriginal CommunityControlled Health Service for which a direction made under subsection 19 (2) of the act applies *Derived fee: 50% ofthe fee for item 16401,16404,16406,16500,16590 or 16591. Benefit: 85% of the derived fee
17609 professional attendance on a patient by a specialist practising in his or her specialty of anaesthesia if: (a) theattendance is by video conference; and (b) item 17610, 17615, 17620, 17625, 17640, 17645, 17650, or 17655applies to the attendance; and (c) the patient is not an admitted patient; and (d) the patient: (i) is located both: (a)within a telehealth eligible area; and (b) at the time of the attendanceat least 15 kms by road from the specialist; or (ii)is a care recipient in a residential care service; or (iii) is a patient of: (a) an aboriginal medical service; or (b) anaboriginal community controlled health service for which a direction made under subsection 19 (2) of the act applies .*Derived fee: 50% of the fee for item 17610, 17615, 17620, 17625, 17640, 17645, 17650, or 17655. Benefit: 85% ofthe derived fee
18219 Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where continuousattendance by the medical practitioner extends beyond the first hour (Anaes.) *Derived fee: The fee for item 18216plus $19.00 for each additional 15 minutes or part thereof beyond the first hour of attendance by the medicalpractitioner.
18227 Intrathecal or epidural infusion of a therapeutic substance, initial injection or commencement of, where continuousattendance by a medical practitioner extends beyond the first hour, for a patient in labour, where the service isprovided in the after hours period, being the period from 8pm to 8am on any weekday, or any time on a saturday, asunday or a public holiday. *Derived fee: The fee for item 18226 plus $28.60 for each additional 15 minutes or partthere of beyond the first hour of attendance by the medical practitioner.
Medical Table of Costs – Schedule of Fees* See Appendix A for derived fee descriptions
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MBS descriptions and rules apply to all items listed FS900 Page 25 of 25
25025 Emergency anaesthesia performed in the after hours period where the patient requires immediate treatment withoutwhich there would be significant threat to life or body part and where more than 50% of the time for the emergencyanaesthesia service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or atany time on a Saturday, a Sunday or a public holiday - not being a service associated with a service to which item25020, 25030 or 25050 applies (0 basic units) *Derived fee: An additional amount of 50% of the fee for theanaesthetic service. That is: (a) an anaesthesia item/s in the range 20100 - 21997 or 22900, plus (b) an item in therange 23010 - 24136, plus (c) where applicable, an item in the range 25000-25015, plus (d) where performed, anyassociated therapeutic or diagnostic service/s in the range 22001-22051
25030 Assistance at after hours emergency anaesthesia where the patient requires immediate treatment without whichthere would be significant threat to life or body part and where more than 50% of the time for which the assistant is inprofessional attendance on the patient is provided in the after hours period, being the period from 8pm to 8am on anyweekday, or at any time on a Saturday, a Sunday or a public holiday - not being a service associated with a serviceto which item 25020, 25025 or 25050 applies (0 basic units) *Derived fee: An additional amount of 50% of the fee forassistance at anaesthesia. That is:(a) an assistant anaesthesia item in the range 25200 - 25205, plus(b) an item in the range 23010 - 24136, plus(c) where applicable, an item in the range 25000-25015, plus(d) where performed, any associated therapeutic or diagnostic service/s in the range 22001-22051
25050 After hours emergency perfusion where the patient requires immediate treatment without which there would besignificant threat to life or body part and where more than 50% of the perfusion service is provided in the after hoursperiod, being the period from 8pm to 8am on any weekday, or at any time on a saturday, a Sunday or a public holiday- not being a service associated with a service to which item 25020, 25025 or 25030 applies (0 basic units) *Derivedfee: An additional amount of 50% of the fee for the perfusion service. That is:(a) item 22060, plus(b) an item in the range 23010 - 24136, plus(c) where applicable, an item in the range 25000 - 25015, plus(d) where performed, any associated therapeutic or diagnostic service/s in the range 22001-22051 or 22065-22075
25200 Assistance in the administration of anaesthesia requiring continuous anaesthesia on a patient in imminent danger ofdeath requiring continuous life saving emergency treatment, to the exclusion of all other patients (5 basic units)*Derived fee: An amount of $99.0 (5 basic units) plus an item in the range 23010 - 24136 plus, where applicable - anitem in the range 25000 - 25020 plus, where performed, any associated therapeutic or diagnostic service/s in therange 22001 - 22051
25205 Assistance in the administration of elective anaesthesia, where: (i) the patient has complex airway problems; or (ii)the patient is a neonate or a complex paediatric case; or (iii) there is anticipated to be massive blood loss (greaterthan 50% of blood volume) during the procedure; or (iv) the patient is critically ill, with multiple organ failure; or(v)where the anaesthesia time exceeds 6 hours and the assistance is provided to the exclusion of all other patients (5basic units) *Derived fee: An amount of $99.0 (5 basic units) plus an item in the range 23010 - 24136 plus, whereapplicable - an item in the range 25000 - 25020 plus, where performed, any associated therapeutic or diagnosticservice/s in the range 22001 - 22051
30001 Operative procedure, not being a service to which any other item in this Group applies, being a service to which anitem in this Group would have applied had the procedure not been discontinued on medical grounds *Derived fee:50% of the fee which would have applied had the procedure not been discontinued
31340 Muscle, bone or cartilage, excision of one or more of, if clinically indicated, and if:(a) the specimen excised is sent forhistological confirmation; and (b)a malignant tumour of skin covered by item 31000, 31001, 31002, 31356, 31358,31359, 31361, 31363, 31365, 31367, 31369, 31371,31372, 31373, 31374, 31375 or 31376 is excised (Anaes.)*Derived fee: 75% of the fee for excision of malignant tumour
44376 Amputation stump, reamputation of, to provide adequate skin and muscle cover (Assist.) *Derived fee: 75% of theoriginal amputation fee
51303 Assistance at any operation identified by the word "assist." for which the fee exceeds $558.30 or at a series ofoperations identified by the word "assist." for which the aggregate fee exceeds $558.30. *Derived fee: one fifth of theestablished fee for the operation or combination of operations
51309 Assistance at a series or combination of operations that include (Assist.) and assistance at a birth involvingCaesarean section *Derived fee: one fifth of the established fee for the operation or combination of operations (thefee for item 16520 being the Schedule fee for the Caesarean section component in the calculation of the establishedfee)
51312 Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627*Derived fee: one fifth of the established fee for the procedure or combination of procedures
51803 Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operationspecified in an item that includes '(Assist.)' for which the fee exceeds $558.30 or at a series or combination ofoperations specified in items that include'(Assist.)' if the aggregate fee exceeds $558.30 *Derived fee: one fifth of theestablished fee for the operation or combination of operations